Navigating High Deductible Health Insurance Plans
For people with high deductible health insurance plans, experiencing ongoing medical issues early on in the plan year can put you at risk of overpaying. Despite the difficulty of navigating how to pay and what to pay, most providers require you to pay your share up front.
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Your physician’s office and medical billers can see how much, if any, of your deductible has been met. At this point it is extremely important that you keep track of several items, including:
the allowable charge the insurance company will pay the provider for the procedure,
your out of pocket payments so far in the plan year; and
the claims submitted by the providers to the insurance company.
The insurance company should provide you an explanation of benefits (EOB) document, showing the claims submitted and the allowable charges.
Providers and hospitals can deny care based on the ability to pay (except when providing emergency room services) for things like screenings and stabilization under the 1986 Emergency Medical Treatment and Labor Act (EMTALA). So, a pre-scheduled medical procedure is not going to be subject to rules that require hospitals to provide care regardless of the patient's ability to pay.
Lastly, Florida law actually rewards individuals who find improper charges on their health care bills. To learn more about health care consumer protections, you can reference this guide from the Florida Department of Financial Services or visit their website at https://www.myfloridacfo.com. The more you know, the better you'll be able to navigate the system.
